Archived: 374-376 Winchester Road

374-376 Winchester Road is a residential care home providing personal care to six people at the time of the inspection. The service can support up to eight people with a learning disability or autism in two houses which have been joined by a single storey extension.

Within limits arising from previous adaptations to the building, the service has been developed and designed in line with some of the principles and values that underpin Registering the Right Support and other best practice guidance. This ensures that people who use the service can live as full a life as possible and achieve the best possible outcomes. The principles reflect the need for people with learning disabilities and autism to live meaningful lives that include control, choice, and independence. People using the service received planned and co-ordinated person-centred support that was appropriate and inclusive for them.

The service was registered for the support of up to eight people in two linked houses. This is in line with current best practice guidance. However, some of the adaptations made did not contribute to a home-like feel.

People’s experience of using this service and what we found

We have identified improvements needed to protect people from risks and make sure they receive care and support in a safe way. These include improvements in the areas of cleanliness, hygiene and infection control, record keeping around medicines, achieving a balance of permanent and agency staff, and notifying us when certain events occur. The registered manager took steps to address some of these concerns during the inspection. There were plans in place to address other concerns.

We have identified improvements needed with respect to the decoration, refurbishment and adaptation of the home to meet people’s needs. Some of these were already known to the provider with plans in place to resolve them.

We have identified improvements needed to make sure concerns identified by the registered manager and the provider’s quality processes are acted on in a timely fashion to sustain the quality of people’s care and support. The provider had put in place a new management team at the area and regional level which had started to show more support for the registered manager.

There were positive, caring relationships between staff and people they supported. Staff promoted and respected people’s dignity, privacy and independence, giving them opportunities to take part in decisions about their care.

People had care and support which met their needs and respected their choices and preferences. The provider complied with the legal standard for supporting people with communication needs arising from a disability or sensory impairment. People had access to a range of appropriate activities which sustained their wellbeing.

The service did not always apply the principles and values of Registering the Right Support and other best practice guidance. These ensure that people who use the service can live as full a life as possible and achieve the best possible outcomes that include control, choice and independence.

The outcomes for most people using the service reflected the principles and values of Registering the Right Support by promoting choice and control, independence and inclusion. Most people were supported to have choice and control of their lives and staff supported them in the least restrictive way possible and in their best interests; the policies and systems in the service supported this practice. However maintenance of the home had not sustained a home-like atmosphere.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk.

Rating at last inspection

The last rating for this service was good (report published 29 March 2017).

This service has been rated requires improvement for two of the last three inspections.

Why we inspected

This was a planned inspection based on the previous rating. The inspection was prompted in part due to concerns received about cleanliness, hygiene and infection control at the home. A decision was made for us to bring forward the planned inspection and examine those risks.

We have found evidence that the provider needs to make improvements. Please see the safe, effective and well led sections of this full report.

Follow up

We will request an action plan from the provider to understand what they will do to improve and sustain the standards of quality and safety. We will continue to monitor information we receive about the service until we return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

The home was last inspected on13 July 2016, when we found breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 and issued warning notices telling the provider they must make improvements. We subsequently inspected the service on 21 November 2016 to check that improvements had been made and the warning notices had been complied with. At that inspection, we found that improvements had been made. At this inspection, we found that improvements had been sustained and the service was providing care in line with the regulations.

A registered manager was not in post at the time of our inspection. A registered manager is a person who has registered with the Care Quality Commission to manage the service. Like registered providers, they are ‘registered persons’. Registered persons have legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run. The service was currently in the process of registering the manager for the home.

Staff spoke highly of the manager and told us they had made changes around the home, which had a positive effect on the safety, efficiency and effectiveness of the service provided. The manager promoted an open door policy, where people or staff were encouraged to come to them with issues, concerns or suggestions.

There were systems and processes in place to monitor the safety of the home and the quality of care. The manager carried out regular auditing and checking of staff competence in their role, then shared feedback and learning to the staff in supervisions, team meetings and training sessions. Incidents were used to enhance learning, understanding, leading to changes to prevent them re-occurring.

The home had a system in place to safely manage people’s medicines. Where people required medicines for pain or anxiety, clear plans were in place to support staff to understand when they were needed. People had access to healthcare services were supported to follow a diet in line with their preferences and dietary requirements.

People’s care plans were detailed and person centred, identifying steps staff needed to take to maintain people’s safety, keep them active, monitor their health and wellbeing and uphold their dignity. Staff were knowledgeable about people, had received relevant training and possessed the skills required in order to effectively support people and keep them safe.

People were supported to lead an active life in the community and staffing had been arranged to enable them to follow their arranged activities as planned. People were encouraged to build their practical skills and participate in the upkeep and cleanliness of their home environment.

Staff sought consent from people before providing care and support. People’s ability to make decisions was assessed in line with legal requirements, ensuring their rights were protected and their liberty was not unlawfully restricted. Decisions were taken in the best interests of people.

A complaints policy was in place. The manager investigated issues and concerns, reflected on feedback and ensured they fed back findings to people who made complaints. The provider informed CQC about important events that happened within the home, in line with regulatory requirements.

We undertook an unannounced comprehensive inspection at 374 – 376 Winchester Road on 13 July 2016 at which breaches of regulations were found. You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for ‘374 -376 Winchester Road’ on our website at www.cqc.org.uk.’

374 -376 Winchester Road is registered to provide accommodation and support for up to eight people who have a learning disability or autism. There were six people living at the home when we carried out the inspection.

The home had a registered manager. A registered manager is a person who has registered with the Care Quality Commission to manage the service. Like registered providers, they are ‘registered persons’. Registered persons have legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run.

People were cared for safely living at 374 – 376 Winchester Road. Environmental risk assessments were managed effectively. The risks to people were minimized through risk assessments. There were plans in place for foreseeable emergencies and fire safety checks were carried out. Infection control procedures were in place and the manager had appointed an infection control lead. Processes were in place to enable the manager to monitor accidents, adverse incidents or near misses.

People received their medicines safely. Staff were trained and assessed as competent to support people with medicines. Medicine administration records (MAR) confirmed people had received their medicines as prescribed.

The home had a registered manager. A registered manager is a person who has registered with the Care Quality Commission to manage the service. Like registered providers, they are ‘registered persons’. Registered persons have legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run.

We found people’s safety was compromised in some areas. People’s medicines were not stored safely and keys for the medicine cabinet were kept where they could be accessed by people and staff who were not authorised to handle medicines. There was no clear guidance for staff on when to administer ‘as required’ medicines.

Environmental risks were not managed effectively; window locks were not secure in the upstairs bedrooms which put people at risk. Not all fire extinguishers were accessible in the event of a fire. Cleaning chemicals that required storing in a locked cupboard could be access by people using the service.

The home was not following guidance recommended by the Department of Health on infection control. One person had been using a mattress which was very stained and dirty.

The two shared bathrooms were not homely or pleasant to use and were unsuitable for people living at the home. Other areas of the home were worn and in need of updating.

People’s care plans provided information to guide staff. However, we found some contained inaccuracies and missing information. There was concerns regarding one person when they put themselves or others at risk. Their plan of care did not offer much information to support them and the person living at the home.

The quality and monitoring system was not effective in order to ensure necessary changes were implemented. These had not picked up the issues relating to the quality and safety of the service provided.

There were enough staff to meet people’s needs. Staff had received training in safeguarding adults and knew how to identify, prevent and report abuse.

Staff received regular one to one sessions of supervision to discuss areas of development. They completed a range of training and felt it supported them in their job role. New staff completed an appropriate induction programme before being permitted to work unsupervised.

Staff sought consent from people before providing care and support. The ability of people to make decisions was assessed in line with legal requirements to ensure their rights were protected and their liberty was not restricted unlawfully. Decisions were taken in the best interests of people.

People received varied meals including a choice of fresh food and drinks. Staff were aware of people’s likes and dislikes and offered alternatives if people did not want the menu choice of the day. People were supported to access healthcare services.

People were cared for with kindness, compassion and sensitivity. Care plans provided comprehensive information about how people wished to receive care and support. This helped ensure people received personalised care in a way that met their individual needs.

People were supported and encouraged to make choices and had access to a wide range of activities. The provider sought feedback through the use of quality assurance questionnaires and is going to use the results to improve the service.

A complaints procedure was in place. There were appropriate management arrangements in place and staff felt supported.

We identified breaches of regulations of the Health and Social care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we have taken at the back of the full version of the report.

People experienced care, treatment and support that met their needs and protected their rights. One person shared some opinions with us. They confirmed they sometimes had their favourite foods at the home and enjoyed the activities they did. They told us that the staff supported them when they needed it and were very happy with the staff in general.

People were protected from the risks of inadequate nutrition and dehydration. They were protected against the risks associated with medicines because the provider had appropriate arrangements in place to manage medicines. People were cared for, or supported by, suitably qualified, skilled and experienced staff. . The provider had an effective system to regularly assess and monitor the quality of service that people received. The records were maintained securely.